Pediatric Annals

Guest Editorial Free

Headaches in Children

Lalitha Sivaswamy, MD; Deepak Kamat, MD, PhD

Headache is one of the most universally experienced ailments; it is rare for a person to have never experienced one. However, certain forms of headache in children, such as migraine, impose not only significant disability due to prolonged periods of pain and school absenteeism, but affect quality of life for the entire family.1 This issue of Pediatric Annals is dedicated to understanding the common and not so common causes of headache in childhood. As practicing clinicians, we must uncover the cause of headache, initiate an appropriate acute or preventive treatment regimen, counsel the family regarding lifestyle changes, and be aware of situations that require referral for in-depth investigations—all in a relatively brief clinic visit.

The symptoms of migraine in childhood can vary significantly from migraine in adults. Knowledge of common migraine precursors and variants, such as paroxysmal torticollis and abdominal migraine in younger children, and unique conditions, such as acute confusional migraine in teenagers, can help the astute clinician make the appropriate diagnosis in the outpatient setting. Dr. A. David Rothner, a renowned expert in the field of childhood headache from the Cleveland Clinic, reviews periodic syndromes specific to childhood in the article “Migraine Variants in Childhood.”

Drs. Marina Khrizman and Ann Pakalnis review treatment options for migraine in the article “Management of Pediatric Migraine: Current Therapies.” Although most drug trials for migraine were conducted in adults, we fortunately now have considerable data to make treatment recommendations for acute migraine in the pediatric age group. Ambiguity still exists regarding how to treat children with chronic migraine as evidenced by The Childhood and Adolescent Migraine Prevention study.2 It is not clear if treatment with a prescription drug is significantly better for a patient with chronic migraine compared to a placebo. Nonetheless, several prophylactic drug options, including natural supplements that can be initiated by the pediatrician are discussed in this article.

Concussion and the sequelae of concussion continue to be major public health concerns.3 Primary care physicians are often on the front line of queries regarding management of postconcussion syndrome and postconcussion headaches. Drs. Raquel Langdon and Sharief Taraman have elaborated on recognition of postconcussion headache, evaluation, and therapeutic strategies in the article “Posttraumatic Headache.” Recent changes in treatment paradigms with respect to “brain rest” are addressed and may be of practical value to primary care physicians who counsel young athletes.

A child with unusual headache symptoms evokes academic curiosity regarding the underlying diagnosis but also discomfort for fear of missing a serious underlying neurological disease. Dr. M. Cristina Victorio outlines some “red herrings” in headache medicine in the article “Uncommon Pediatric Primary Headache Disorders.” Recognizing an infrequent constellation of clinical features can be gratifying to the clinician and save the family a visit to the emergency department or a neurologist. Some of these disorders can be quickly diagnosed by a directed history or a photograph of the child during the episode. Specific treatment options exist in most instances.

The final article, “Life-Threatening Headaches in Children: Clinical Approach and Therapeutic Options” by Drs. Nagma Dalvi and Lalitha Sivaswamy, discusses the symptoms and signs of neurological disorders that, if left unrecognized, can lead to death or marked disability in the form of stroke or blindness. In most cases, associated neurological signs can guide the clinician toward the correct imaging modality. Recognition of these signs requires only a detailed bedside neurological examination and knowledge of certain “red flags.”

We hope this issue provides a framework for thoughtful management, referrals, investigations, and treatments for pediatric headache concerns; most importantly, we hope that pediatric clinicians have gained some tools to reassure patients and their families that there are no underlying brain disorders if that is indeed the case.


  1. Orr SL, Christie SN, Akiki S, McMillan HJ. Disability, quality of life, and pain coping in pediatric migraine: an observational study. J Child Neurol. 2017;32(8):717–724. doi:. doi:10.1177/0883073817702025 [CrossRef]
  2. Powers SW, Hershey AD, Coffey CSCHAMP Study Group. The Childhood and Adolescent Migraine Prevention (CHAMP) study: “what do we do now?”Headache. 2017;57(2):180–183. doi:. doi:10.1111/head.13025 [CrossRef]
  3. Hyder AA, Wunderlich CA, Puvanachandra P, et al. The impact of traumatic brain injuries: a global perspective. Neurorehabilitation. 2007;22(5):341–353.

About the Guest Editors

Lalitha Sivaswamy, MD
Deepak Kamat, MD, PhD

Lalitha Sivaswamy, MD, is an Associate Professor of Pediatrics and Neurology at Wayne State University School of Medicine; and the Program Director for the Child Neurology Residency program, and a Practicing Pediatric Neurologist at the Children's Hospital of Michigan. She graduated from medical school in India, completed her pediatric residency at Henry Ford Hospital and pediatric neurology residency at the Children's Hospital of Michigan. Her areas of interest are student and resident education. She is an Associate Editor of the Journal of Pediatric Neurology and a reviewer for several peer-reviewed journals in child neurology.

Address correspondence to Lalitha Sivaswamy, MD, via email:

Deepak Kamat, MD, PhD, is a Professor of Pediatrics, the Vice Chair of Education in the Department of Pediatrics at Wayne State University and the Designated Institutional Official for the Children's Hospital of Michigan.

Dr. Kamat received his medical and doctorate degrees from the University of Bombay in India and then completed his residency in pediatrics and fellowship training in immunology at the University of Minnesota. He is board certified in pediatrics and in clinical and laboratory immunology.

Dr. Kamat served as the Director of the combined Medicine/Pediatrics Residency program at the University of Minnesota and as the Director of the Pediatric Residency Program at the Children's Hospital of Michigan. He developed an international pathway for residents at the University of Minnesota and at the Children's Hospital of Michigan. He has been honored with “Teacher of the Year” awards by medical students and residents on multiple occasions. In 2009, he received the Wayne State University Board of Governor's Faculty Recognition Award, in 2010 he received the “National AAP Education Award,” and in 2012 he received the Excellence in Teaching Award from the President of Wayne State University.

Dr. Kamat is active in multiple national and international medical societies. He has authored and co-authored over 200 peer-reviewed manuscripts, review articles, book chapters, and case reports. He serves on the editorial board of five journals and as an ad hoc manuscript reviewer for many journals. He is one of the editors of the American Academy of Pediatrics' first textbook of pediatrics, Textbook of Pediatric Care, and editor-in-chief for Pediatric Care Online of AAP, and Quick Reference Guide to Pediatric Care. He is co-editor of the Textbook of Global Child Health and editor for The Challenging Cases in Pediatric Diagnosis.

Dr. Kamat was a member of the Pediatric Review Committee of ACGME (Accreditation Council for Graduate Medical Education) from July 2011 through June 2017.

Address correspondence to Deepak Kamat, MD, PhD, via email at

Disclosure: The authors have no relevant financial relationships to disclose.


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